I called the insurance company (BlueCross/Aetna Prudent Buyer PPO). As expected, they said there is nothing they can do; I went over my $750 annual limit for well-child care. In the future I should make sure I stay under the limit.
Next, I called the business office of the doctor's group. I expected them to discount some of the charges. Why? I don't know -- out of the kindness of their hearts, perhaps.
The lady in customer service said no, there are no discounts for which I am eligible. In some instances, there is a 25% discount for prompt payment, but not in this case. This is a balance due to going over a benefit maximum -- that is, it already has been touched by insurance -- and therefore is ineligible for the 25% discount. There are no discounts that apply...
If I let my balance due go over 90 days, I am eligible for a 10% "settlement offer." After 90 days of my balance being due, I can call the business office and ask for the settlement offer. I will be given a 10% discount, which, for me, will be $60-$70 per round of vaccines.
The catch is that after 90 days, past-due balances are sent to a collections agency. In order to avoid collections, I must call and pay between 90 days past-due and 99 days past-due. One day more and collections will receive my balance, and the 10% discount is gone.
I asked the lady one more question.
"How," I asked, "am I supposed to know how much a doctor's visit will cost, so that I can plan ahead in the future?"
"You can call the doctor," she replied, "and ask for the exact procedure codes for each procedure that will be done at the visit. Then you can call us at the business office and read off the procedure codes. We can calculate what the visit will cost." We shall call this item A.
Next, I would take this information to the insurance company. I would call and ask which procedures are covered, and how much. I would ask how close I am to meeting my maximum benefit. This is item B.
Finally, I would subtract item B from item A and get item C -- the amount the well-child visit would cost me out of pocket.
Oh, a simple four-step process. Excuse me as I drip with sarcasm.
I told the lady that unfortunately, for financial reasons, we will not be returning to the medical group for any of our medical needs, and will seek another doctor.
She was unfazed.